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This chapter provides the basic steps of performing a TAVR. Use this as a foundation, and then learn when to do things differently or correct problems. While some TAVR experts may do things differently, the conservative techniques described here will allow a safe TAVR procedure. Perfecting each step is critical to preventing complications.

Access to the aortic annulus is often the limiting step in TAVR procedures. Peripheral vascular disease may require transapical, trans-subclavian, transcarotid, transcaval, or direct ascending aortic access. Each method has various technical considerations and risk profiles. Working knowledge in all access points for TAVR will make you a valuable member of the team.

This chapter includes the basics for working in a catheterization laboratory. For cardiologists, this will be remedial. For cardiac surgeons, this will provide you with beginning knowledge but nothing can surpass experience. Spending time in the cath lab is the best way to learn catheter-based intervention.

There are various considerations when selecting a TAVR device for a particular patient. Subtleties in anatomy and clinical situation as well as operator familiarity will serve as a guide.

Due to the large-bore access required in the initial TAVR experience, most early centers used general anesthesia for patients undergoing TAVR. As sheath size decreased and access converted from cutdown to fully percutaneous access and closure, a shift toward conscious sedation has occurred.

A wealth of clinical research in TAVR, primarily via randomized clinical trials and large registries, informs clinical decision-making in TAVR. Paramount among these trials have been the PARTNER and Medtronic extreme and high-risk trials. Understanding these studies will provide a basic knowledge, context for future clinical research, and important information for counseling patients in TAVR therapy.

A thorough preoperative evaluation is paramount in performing successful TAVRs. All supporting literature in TAVR was done following careful risk stratification. This chapter addresses not only indications and contraindications but also special scenarios such as bicuspid aortic valve and bioprosthetic valve degeneration.

Despite being minimally invasive, TAVR procedures come with significant procedural risk. In the high-risk TAVR patient, brief moments of instability can lead to cardiac arrest. Preparedness for procedural complications requires clear planning ahead of time. Below are tips to consider prior to an emergency.

This chapter discusses the durability of TAVR valves over time using the PARTNER database and CoreValve registry.

This chapter provides interesting and complicated TAVR cases. These cases include ventricular perforation, coronary inclusion, annular rupture, and paravalvular leak.

Immediate postoperative management of TAVR patients includes early ambulation, medical therapies, planning for early discharge, and monitoring of common and uncommon complications. Taken together, these actions allow for a smooth transition post-TAVR procedure.

Risk of major vascular complications clearly depends on the access route and is reported between 5 and 16%. The evolution of delivery systems with decreasing profile size has helped significantly to reduce complications and allow more transfemoral procedures. Any unexplained tachycardia, hypotension, or anemia should raise your suspicion for an iliac or femoral injury. Vascular complications can present after surgery when patients are hypertensive or resume anticoagulation.